摘要：目的 降低经皮肾碎石术(PNL)中肾残石的发生率.方法 术前CT肾盂三维成像获得肾盂的形态及各肾盏的形态及其分布信息,判定集合系统有无畸形,确定可否行PNL,在此基础之上建立经皮肾单通道或多通道,并且彩超判定通道区域的血管情况,调整穿刺方向,规避血管,避免术中大出血,采用术中超声弹道气压碎石,配合低压大流量冲洗,术中B超动态监测等措施.结果 98例肾结石患者,单微通道碎石50例,多通道碎石15例,大通道碎石33例,其中二次碎石10例,多次行体外冲击波碎石术(ESWL)碎石5例,全部取石成功.结论 术前CT肾盂三维成像,术超探测,合理选择建立通道,超声弹道碎石,低压大流量冲洗,B超动态监测,术后ESWL能降低经皮肾碎石残石发生率. Abstract： Objective To reduce the ratio of retained calculus after percutaneous nephrolithotripsy (PCNL). Methods The forms of pelvis and renal calices and the distributions of renal calices were obtained to decide whether the collecting systems were malformed and to receive PCNL or not by CT three-dimensional imaging of pelvis preoperatively. Based upon this, we established single channel or multi channel for PCNL, and adjusted the puncture direction in order not to destroy vessels and prevented massive intraoperative hemorrhage by colour ultrasonography. Subsequently, we used air-pressure ballistic ultrasonic lithotresis during operation, in combined with high-flow and low-pressure washing, observation by B-ultrasound intraoperatively. Results Of all the total 98 patients with renal calculus, 50 patients received single-channel lithotripsy, 15 patients received multi-channel lithotripsy, 33 patients received big channel lithotripsy. Ten patients were carried out lithotripsy for the second time, 5 patients received lithotripsy several times. All the patients received operations successfully. Conclusions The following measures, preoperative CT three-dimensional imaging of pelvis, intraoperative

关键词：经皮肾碎石术 残石 预防与处理 多通道 低压大流量 

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